What is obesity?

Because of these risks, it is
important to lose weight even if you don't feel bad now. It is hard to change
eating habits and exercise habits. But you can do it if you make a plan.

How do you know if you are obese?

You can use a
measurement called a body mass index, or BMI, along with your waist size, to decide whether your weight is
dangerous to your health. The BMI is a combination of your height and weight.
If you have a BMI of 30 or higher, unhealthy eating patterns,
and too little physical activity, your extra weight is putting your health in
danger.

People who
carry too much fat around the middle, rather than around the hips, are more
likely to have health problems. In women, a
waist size of 35 in. (88 cm)
or more raises the chance for disease. In men, a waist size of
40 in. (101 cm) or more raises
the chance for disease.footnote 1

If you are Asian, your health may be at risk if you have a BMI of 27.5 or
higher and you have unhealthy eating patterns
and too little physical activity. Also, health
problems are seen with a smaller waist size. In Asian women, a waist size of
32 in. (80 cm) or more raises
the chance for disease. In Asian men, a waist size of
36 in. (90 cm) or more raises
the chance for disease.footnote 2

What causes obesity?

When you take in more
calories than you burn off, you gain weight. How you eat, how active you are,
and other things affect how your body uses calories and whether you gain
weight.

If your family members are obese, you may have inherited
a tendency to gain weight. And your family also helps form your eating and
lifestyle habits, which can lead to obesity.

Also, our busy lives
make it harder to plan and cook healthy meals. For many of us, it's easier to
reach for prepared foods, go out to eat, or go to the drive-through. But these
foods are often high in saturated fat and calories. Portions are often too large. Work
schedules, long commutes, and other commitments also cut into the time we have
for physical activity.

You've tried diets, but you always gain the weight back. What can you do?

Focus on health, not diets.
Diets are hard to stay on and usually don't work in the long run. It is very
hard to stay with a diet that includes lots of big changes in your eating
habits.

Instead of a diet, focus on lifestyle changes that will
improve your health and achieve the right balance of energy and calories. To
lose weight, you need to burn more calories than you take in. You can do it by
eating healthy foods in reasonable amounts and becoming more active. And you
need to do it every day.

Little steps mean a lot. Losing just
10% of your body weight can make a
difference in your health.footnote 1

Make a plan for change. Work with your doctor to create a plan that will work for you.
Ask family members and friends for help in keeping with your plan. Ask your
doctor to recommend a dietitian to help you with meal planning.

When you stray from your plan, don't get upset. Figure out what got you
off track and how you can fix it.

How can you stay on your plan for change?

It's
hard to change habits. You have to be ready. Make sure this is the right time
for you. Are you ready to make a plan and stay on it? Do you have the support
of your family and friends? Do you know what your first steps will be? Becoming
healthier and staying that way is a lifelong effort.

Most people
have more success when they make small changes, one step at a time. For
example, you might eat an extra piece of fruit, walk 10 minutes more, or add
more vegetables to your meals.

Studies show that people who keep
track of what they eat are better at losing weight. Keep a notebook where you
can write down everything you eat and drink each day. You may be surprised to
see how much you are eating. Use a calorie counter to add up your calories.
(You can find calorie counters online and at bookstores.)

As you
keep track of calories, look at whether you skip meals, when you eat, how often
you eat out, and how many fruits and vegetables you eat. Keep track of when you eat beyond feeling full and if you eat for reasons other than being hungry. This will help you see
patterns that you may want to change.

You may want to write down
the amount of physical activity you've had each day and compare the calories
you burned to those you took in. Use the
Interactive Tool: How Many Calories Did You Burn? to see how many
calories you burn through daily activities.

Can you take medicines or have surgery to lose weight?

Surgery
and medicines don't work by themselves. Most people also need to make changes
in what they eat and how active they are.

Before your doctor will
prescribe medicines or surgery, he or she will probably want you to work on
healthier eating and activity for at least 6 months. Even if your doctor gives you
medicines or recommends surgery, you will need to keep your new healthy habits
for the rest of your life.

Your lifestyle. Modern conveniences—such as elevators,
cars, and the remote control for the television—cut activity out of our lives.

Your genes. If one of your parents is
obese, you are more likely to be obese than someone who has parents of healthy
weight.

Your friends and family.
If they eat a lot of snack foods high in saturated fat, eat at irregular times, and skip meals, you probably
will too. And if they are not physically active, you may not be either.

Other things influence your weight and whether you are physically active,
including:

Low self-esteem. Being
overweight or obese may lower your
self-esteem and lead to eating as a way to comfort
yourself. Repeated failure at dieting also can affect your self-esteem and make
it even harder to lose weight.

Emotional concerns. Emotional
stress,
anxiety, or illnesses such as
depression or chronic pain can lead to overeating.
Some people eat to calm themselves, to avoid dealing with unpleasant tasks or
situations, or to dampen negative emotions.

Trauma. Distressing events—such as childhood sexual,
physical, or emotional abuse; loss of a parent during childhood; or marital or
family problems—can contribute to overeating.

Alcohol. Alcohol (beer, wine, and mixed drinks)
is very high in calories.

If you have healthier habits or lose
weight, your risk for these conditions is reduced.

Where you carry fat

If fat builds up mostly around your stomach (sometimes
called apple-shaped), you are at greater risk for type 2 diabetes, high blood
pressure,
high cholesterol, and coronary artery disease than
people who are lean or people with fat around the hips (sometimes called
pear-shaped). Your waist size affects your risk of health problems.

People
with obstructive
sleep apnea who lost as little as 10% of their weight
improved their sleep patterns and had less daytime sleepiness.footnote 3

Exams and Tests

Along with a regular medical
checkup, you may have some tests to check on your health.

Your
doctor may want to do blood tests to check for
type 2 diabetes,
thyroid or liver problems, and
high cholesterol or
high triglyceride levels.

Your doctor
will check your blood pressure, ask about any medicines you are taking, and
discuss your medical history and your family's medical history. He or she will
ask how active you are, whether you drink alcohol (and how much), your history
of weight gain, and how often you have tried to lose weight.

Tests are available to estimate your body fat percentage (to find out about how much of your weight is fat). This is different from your BMI. With some of these tests, you may also learn your basal metabolic rate (BMR). Knowing your BMR can help your doctor or registered dietitian plan how many calories you need each day.

Early detection

Doctors use BMI to help screen for unhealthy weight. If you have a BMI of 30 or higher, your extra weight—as well as unhealthy eating patterns and too little physical activity—may be putting your health in danger. If you are Asian, your health may be at risk with a BMI of 27.5 or higher.footnote 2

If you're concerned about your child's weight

If you have concerns that your child is overweight or at risk of becoming so, ask your doctor to review your child's growth charts and medical history with you. If your child's BMI and growth pattern suggest a weight problem, your doctor will give your child an exam to look for problems that can cause weight gain. He or she may ask questions about eating and exercise habits. Regular checkups will also be important over time.

Treatment Overview

Treatment for
obesity will be most successful if you create a
long-term plan with your doctor. A reasonable goal might be to begin making
lifestyle changes by increasing physical activity and eating healthy foods. Your initial goal should be to improve your health, not to achieve an
ideal weight.

Guidelines suggest
a goal of losing 10% of your body weight in 6 months.footnote 1 Doctors often recommend that people make lifestyle changes for at least 6 months before trying
medicines or surgery.

Your doctor may also
suggest
counseling. If you use food to cope with depression,
loneliness, anxiety, or boredom, you need to learn new skills to deal with
those feelings.

Eat less

Eating fewer calories
while increasing activity is the best way to lose weight. Focus on smaller portion sizes.

People often convince themselves that they don't
overeat. Keeping a food journal(What is a PDF document?) can help you find out how many calories you consume in a day. Then you can set a goal with your doctor or dietitian according to your needs.

Limiting your calories to very low levels might seem like the way to quick weight loss. But it can have serious negative effects on your body and your ability to keep the weight off.

Limiting calories and portion size—not limiting the types of
foods you eat—causes more weight loss over the long term. For example, cutting only carbohydrate
or fat will not cause any more weight loss than a healthful eating plan.

Eat healthier foods—don't diet

Rather than focusing
on a particular type of diet, try to eat healthier foods. Don't try to restrict
the foods you love. Eat less of them. Eat smaller portions.

Keep track of your steps with
a step counter or pedometer. If you have a desk job, you may be surprised to
see how little you move in a typical day. Start with a goal of
increasing your steps by 2,000 steps a day and work up to 10,000 to 12,000.

Get checkups

See your doctor after 6
months to check your progress. Some people stop losing weight around this time,
because their bodies adjust to fewer calories and their motivation starts to
slip.

At this point your doctor may want you to increase your
activity and revisit the dietitian to make further changes to your eating habits. Your
goals may switch from losing more weight to keeping the weight off. Staying
active is very important.

If you have
lost weight but gained it back, don't be discouraged. It is not uncommon to try
several times before weight comes off and stays off. Talk to your doctor about
starting again. It may be helpful to work with others who are trying to lose
weight by following a structured program.

When to consider medicines or surgery

If you do
not lose weight, continue to gain weight, or have lost weight several times
only to regain it, or if your doctor is concerned about a
related health problem, you might need to try
medicines or surgery.

Weight-Loss Strategies and Programs

Most weight-loss programs can help you lose weight at first. But you will lose
more and have more health benefits if you can keep with it for a longer time.
You need to find the right balance of
eating and physical activity that you can keep doing or a program that works
with your lifestyle.

Are you ready to make changes?

Before you begin treatment,
decide if you are ready to make the lifestyle changes needed to lose weight.
Losing weight and keeping it off can be hard. Think
about successes that you had before and how you were able to achieve them.

If you are
ready to make a plan for healthier eating, your doctor may suggest losing 10% of your weight at a rate of
1 lb (0.45 kg) to
2 lb (0.9 kg) a week as your
first target. Research shows that a 10% weight loss can improve your
health.footnote 1 It is better that you maintain a small amount
of loss rather than lose a lot of weight fast and gain it back.

Tips to help with your weight-loss program

Set realistic goals. Many people expect to
lose much more weight than is realistic. Think about why you want to lose weight, and prepare for slip-ups.

Find what
works best for you. Finding a plan that includes daily menus and
recipes may be best.

Get family and friends involved to provide
support. Talk to them about why you are changing your eating habits and physical
activity and how important losing weight is to you.

Identify obstacles to losing weight. Keep a food journal(What is a PDF document?). Look at it to try to find things that cause you to overeat, such as stress or
depression.

Replace unhealthy food temptations with healthier foods such as fruit and low-fat
yogurt.

Think ahead about situations that may be
hard. Ask yourself if you are eating for reasons other than hunger:

Have you noticed a change in your eating
or weight since a change occurred in your lifestyle or stress
level?

Do you use
food as a reward?

Do
you eat whatever is most available because you don't plan ahead?

Weight-loss programs

Many commercial weight-loss programs (such as
Weight Watchers or Lifesteps) and self-help or support groups (such as
Overeaters Anonymous) are available. The quality and effectiveness of
programs vary widely, from reputable obesity clinics associated with hospitals
to quick weight-loss schemes that may even harm your health with untested
"miracle" products.

When
considering a weight-loss program, ask
questions about the staff's qualifications and whether counseling is offered.
Be aware that the advertising strategies for weight-loss programs and products,
such as using celebrities and "before and after" pictures, are usually
unrealistic.

Medications

Most weight-loss medicines for
obesity work by making you feel less hungry or making
you feel full sooner. They are used together with healthy eating habits and exercise.

Medicine is generally used only for those who have a
body mass index (BMI) of 30 or higher. But they
sometimes are used for those with a BMI of 27 or higher who are at risk for
high blood pressure,
high cholesterol,
coronary artery disease,
type 2 diabetes, and
sleep apnea.footnote 1

Medicine choices

Bupropion/naltrexone (Contrave) is a prescription medicine. Contrave may reduce your appetite. It may help you avoid overeating.

Liraglutide (Saxenda) is a prescription medicine that is given by a shot once a day. It may help you eat less.

Lorcaserin (Belviq) is a prescription medicine that you take twice a day. It can help you eat less and feel satisfied with eating smaller amounts of food.

Orlistat (Xenical)
is a prescription medicine that prevents some of the fat calories you eat from
being absorbed in your intestines. Prescription orlistat is the only weight-loss medicine that is approved for children. It is meant to be used only in children over the age of 12.

Orlistat (Alli) is also available
over the counter. Alli contains half of the medicine
that is in Xenical. Over-the-counter orlistat is not meant for use by anyone under the age of 18.

Phentermine/topiramate (Qsymia) is a prescription medicine that combines the drugs phentermine and topiramate. Taking it once a day can help you eat less.

What to think about

Medicine doesn't
work for everyone. And medicine alone is not as effective as when it is combined with
healthy eating habits or activity.

Surgery

Surgery may be an option if you have a
body mass index (BMI) of 40 or more. It may also be an option if you have a BMI of 35 and another health
problem related to your weight, such as
diabetes or
arthritis.

Experts are still debating whether surgery for obesity is okay for children.

The goal of surgery is to cause
significant weight loss. This should reduce
obesity-related health problems, including type 2
diabetes and
high blood pressure.

Surgery can help you lose weight in a couple of ways. Restrictive operations (such as adjustable gastric band ) reduce how much food you can eat by making the stomach smaller. Malabsorptive operations (such as Roux-en-Y gastric bypass) make it harder for your body to digest and absorb food.

It is important to
remember that you may still be obese or overweight after the surgery. Also,
surgery will require you to make extreme changes in how you eat, such as eating
only a few ounces of food at a time because the surgery creates a much smaller
stomach.

Surgery choices

Nutrition concerns

After surgery, you
will need to learn new ways to eat. You'll need to eat very slowly and
chew your food well. You will not be able to drink for 30 minutes before eating, during your
meal, and for 30 minutes after eating. If you don't make these changes, you may vomit frequently
and have pain. You may also develop nutrition problems.

Your doctor may recommend calcium, iron, and
vitamin supplements.

What to think about

All surgeries have risks. Discuss your treatment options
with your doctor to decide what is best for you.

Most people who
have surgery to treat obesity begin to lose weight quickly. Weight loss usually
continues for about 2 years.

Risks common to all surgeries for
weight loss include an infection in the incision, a leak from the stomach into
the abdominal cavity or where the intestine is connected (resulting in an
infection called
peritonitis), and a blood clot that blocks blood flow
in the lung (pulmonary embolism). Some people develop
anemia or
osteoporosis.

It is important to
compare the risks of being obese with the risks of surgery.

Other Places To Get Help

Organization

Shape Up America! Healthy Weight for Life

www.shapeup.org

Related Information

References

Citations

National Heart, Lung, and Blood Institute, National
Institutes of Health (2000). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (NIH Publication No. 00-4084). Available online:
http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf.

National Heart, Lung, and Blood Institute, National
Institutes of Health (2000). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (NIH Publication No. 00-4084). Available online:
http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf.

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How this information was developed to help you make better health decisions.